Republic of the Philippines

Department of Education
REGION I
SCHOOLS DIVISION OFFICE I PANGASINAN
NAME OF SCHOOL
ADDRESS OF SCHOOL

2019-NCOV ARD SCHOOL HEALTH SITUATION REPORT

SCHOOL DISTRICT: __________________

SCHOOL ID: ________________
SCHOOL NAME: ___________________________________
REPORT FOR THE WEEK OF: ________________________________

I. Referral of Persons with Symptoms of Respiratory Infection

No. Name Grade Sex Age Remarks (reason for referral,
Level referred to)

II. School Activities Undertaken (Brief)

Date Title of Activity Participants (Number/Profile)
Ex. February Orientation on Proper 100 Grade 3 learners
14, 2019 Handwashing 10 Elementary School Teachers

III. Needs and Recommendations

Prepared by:

__________________________

Approved for submission:

School Head

Address: NNNNNNNNN
Telephone No.: (075)-000-000
Email: NNNNNN